Not many women know of the availability of laparoscopic (keyhole) surgery.

This was emphasised in a simple survey of all the female drug representatives who visited me, where I found that very few of these generally well-informed women had heard of laparoscopic surgery.

Most of them asked how conditions such as a fibroid or endometriosis could be treated with this type of surgery.

The most common questions I get from female patients are: “How can you remove a large fibroid through a small incision?” and “I was told by my doctor that laparoscopic surgery is not as thorough as traditional laparotomy”.

If surgery has been recommended to you, it is always advisable to go for a second opinion as there is always room for alternatives.

As a patient, you will have additional insight into your condition and the medical options available to treat that condition.

Most significant during the consultation is the conversation you have with your gynaecologist on your concerns.

Laparoscopy is minimally-invasive surgery, usually performed using three to four small incisions and involving the use of a small camera that is inserted through one of the incisions to allow a surgeon to see clearly inside the body.

The area being operated on is enlarged on a video screen, allowing the surgeon to clearly view the surgical area.

The procedure requires much smaller incisions than are used in traditional open gynaecological surgeries.

Due to the small incisions, the surgical wounds heal fast and patients experience very little postoperative pain.

There are also only small scars left on the abdomen. The chances of wound infection are low and bleeding during laparoscopic surgery is also minimal.

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The basic principles of laparoscopic surgery.

For many gynaecological procedures, such as removal of an ectopic pregnancy or treatment of endometriosis or ovarian cystectomy, laparoscopy has become the treatment of choice.

Compared with laparotomy, multiple studies have shown that laparoscopy is the less expensive option due to a shorter hospital stay and a shorter recovery time.

The advantages of the laparoscopic approach over other procedures, including hysterectomy, sacrocolpopexy, and the staging and treatment of gynaecologic cancers, continue to broaden.

Upon my recommendation of the procedure, the next question I usually get is on the safety of laparoscopic surgery in comparison to traditional laparotomy.

This will depend on the expertise and experience of the doctor.

While complications may occur in both open laparotomy and laparoscopic surgeries, the most important aspect is that the performing surgeon can diagnose and correct the complications immediately.

Over the years, laparoscopic techniques have also continued to evolve, primarily as a result of technological advances.

In addition to better cameras and instruments, technology has resulted in the development of 3D laparoscopy, and more recently, single incision laparoscopy, where the surgery is performed with just a single incision in the umbilicus.

This advancement is cosmetically advantageous because the incision is made in the “hidden” umbilicus.

These methods are available and currently being used here in Malaysia.

However, only 5% of gynaecological conditions are being treated in Malaysia via the laparoscopic route.

Due to the lack of awareness, we are far behind other Asian countries such as Singapore, Taiwan, Japan and Korea, where more than 50% of benign gynaecological diseases are performed laparoscopically.

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The different types of fibroid.

With all the benefits tied to the procedure, women should take charge of their medical care by educating themselves about laparoscopic surgery.

At some point in life, some of us may be required to go through surgery.

It is always something that requires a great deal of thought and consideration as it involves some discomfort, risk and disruption to one’s life.

Begin your own healing and recovery from surgery by taking charge of the decisions that need to be made.


Dr S. Selva is a consultant obstetrician and gynaecologist, and the author of Laparoscopic Surgery in Gynaecology and Common Diseases in Women.